| NPI | 1760112924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-51667) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-11047) |
| Enumeration Date | 2022-06-12 |
| Last Update Date | 2025-12-05 |